We have presented the final quotes to LDRM for review. We are anticipating another bevy of excuses as to why we can’t choose plans that actually cover care. Here are the prices and plan documents for you to review.
The PPO 80/60 Premium and PPO 80/50 Enhanced allow you to choose your level of prescription coverage, which are explained in the plan documents. The PPO 80/50 Basic has Prescription Plan F, the lowest available prescription plan. Your insurance premium total is based on your plan choice, level of coverage, and prescription plan choice.
Example: An Employee only PPO Premium plan with Option A prescription coverage would be $774.36 per month, or $357.40 per pay period. This would leave a residual $116.20 per pay period in H&W to be cashed out.
Things to keep in mind:
- The PPO Premium is exactly that, a Premium plan, it has $20 copays for your doctor, specialists (Chiropractor, OT/PT, etc.), Urgent Care, and a $40 copay for the ER. All of that with a $300 deductible.
- As much as we push that the H&W is your money (because it is), at “normal” job you would likely be paying 20% of the premium (20% of the above example is $154.87, and for the same plan you are getting $116.20 in your pocket instead.
- With the exception of the PPO Premium plan, the plans were improved with while improving costs in most cases.
- The increases that did occur are slight and should be offset by the copay and deductible adjustments
- The levels of coverage might convince more people to carry insurance through these plans
- When contractors change, our insurance coverage doesn’t
- We have control of our own insurance plans! We can review and make changes to the plans as necessary for next year.
Here again are the comparisons updated with the new USW information.
FCE Standard Plan v BC/BS PPO 80/50 Basic
For those who don’t plan on using their insurance unless absolutely necessary
- Higher co-pays – $50 office/ $75 Specialist/ $75 Urgent Care/ $200 ER
- Higher Deductibles – $5,000/$10,000
- Comes with Prescription Option F
FCE HSA Plan v BC/BS PPO 80/50 Enhanced
For those who use their insurance more often
- Affordable co-pays – $20 office/ $40 Specialist/ $40 Urgent Care/ $100 ER
- Half the deductible of PPO Basic – $2,500/ $5,000
- Choice of Prescription Options
FCE Plus Plan v BC/BS PPO 80/60 Premium
Pay up front in the premium so you pay less when you need to use it
- Lowest co-pays $20 office/ $20 Specialist/ $20 Urgent Care/ $40 ER
- Very low deductible – $300/ $600
- Choice of Prescription Options
Terms you should know:
- Premium – what you pay per month/ pay period for insurance coverage
- Co-pay – what you pay at that visit
- Deductible – amount that must be paid prior to Co-Insurance will be in effect
- Co-Insurance – percentage that is a shared responsibility between the insured and insurer
The plan documents list how much the insurer pays as 80%, which means you are responsible for the remaining 20% after the deductible has been met
- Out-of-pocket Maximum – the most that you will pay out of pocket for medical services
The PPO plans list a “Limit” which excludes co-pays, deductible, RX cost share, and amounts in excess of the “Allowable Charge”; and a “Total” which includes all costs.
Ex. – if you have a procedure any costs paid after the deductible is met apply to the “Limit”, all costs of the procedure would count towards the “Total”
- Formulary – an approved list of prescription drugs